Emergency and Urgent Care
Piedmont members are covered for emergency and urgent care anywhere in the world at any time.
We understand that emergencies and urgent situations happen while you are outside the Piedmont service area. In these situations you should seek immediate care. Because the Piedmont network only covers certain areas, we do however ask you to notify us when these situations happen so we can help you get the proper treatment and the proper claims processing.
So if something happens while you are on vacation or while you are traveling for work, don't worry - we are here to help. And just because you are out of the area doesn’t mean you don't have network access. Piedmont contracts with networks throughout the state of Virginia and nationally to help reduce the costs of medical treatment for you and your family.
Just contact us and we'll help you find a nearby network participant, but in a life-threatening emergency, simply go to the nearest facility.
Within the Service Area
Medical Care is available through your Primary Care Physician 7 days a week, 24 hours a day. If you need medical care, you should call your Primary Care Physician immediately for instructions on how to receive care. If the Emergency is such that immediate action is required, you should be taken to the nearest appropriate medical facility. Piedmont covers services rendered by providers other than Piedmont Providers when the condition treated is an Emergency as that term is defined in this Certificate of Coverage.
A telephone call from you to your Primary Care Physician while at an urgent care center or Emergency room will not be treated by Piedmont as a proper referral for Urgent Care or other non-Emergency services. You must contact your Primary Care Physician before going to the urgent care center or Emergency room in order to obtain a proper referral for Urgent Care or other non-Emergency services.
Emergency services provided within Piedmont's Service Area will include Covered Services from non-Piedmont Providers only when a delay in receiving care from a Piedmont Provider could reasonably be expected to cause your condition to worsen if left unattended.
Outside the Service Area
Urgent Care and Emergency services outside the Service Area are Covered Services if you sustain an injury or become ill while temporarily away from the Service Area. Accordingly, benefits for these services are limited to care which is required immediately and unexpectedly. Neither elective care nor care required as a result of circumstances which could reasonably have been foreseen prior to departure from the Service Area is a Covered Service.
Benefits for maternity care or childbirth do not include normal term delivery outside the Service Area, but do include earlier complications of pregnancy or unexpected delivery occurring outside the Service Area.
If an Emergency or Urgent Care situation occurs when you are temporarily outside the Service Area, you should obtain care at the nearest medical facility. You or your representative are responsible for notifying your Primary Care Physician or Piedmont within 24 hours or on the next working day. Failure to do so may result in reduced benefits or no benefits.
Benefits for continuing or follow-up treatment must be pre-arranged by your Primary Care Physician or Piedmont and provided in the Service Area by Piedmont Providers and are subject to all provisions of this Certificate of Coverage.
In the event of an Emergency requiring hospitalization, or for which Outpatient Emergency services are necessary, you or your representative must notify your Primary Care Physician or Piedmont within 24 hours after care is commenced or on the next working day. This applies to services received inside or outside the Service Area.